Abstract
BackgroundLetters are regularly sent by healthcare organisations to healthcare professionals to encourage them to take action, change practice or implement guidance. However, whether letters are an effective tool in delivering a change in healthcare professional behaviour is currently uncertain. In addition, there are currently no evidence-based guidelines to support health providers and authorities with advice on how to formulate the communication, what information and behaviour change techniques to include in order to optimise the potential effect on the behaviour of the receivers. To address this research gap, we seek to inform such guidance through this systematic review, which aims to provide comprehensive evidence of the effectiveness of personal letters to healthcare professionals in changing their professional behaviours.Methods/designA comprehensive literature search of published and unpublished studies (the grey literature) in electronic databases will be conducted to identify randomised controlled trials (RCTs) that meet our inclusion criteria. We will include RCTs evaluating the effectiveness of personal letters to healthcare professionals in changing professional behaviours. The primary outcome will be behavioural change. The search will be conducted in five electronic databases (from their inception onwards): MEDLINE, Embase, PsycINFO, the Cochrane Library and CINAHL. We will also conduct supplementary searches in Google Scholar, hand search relevant journals, and conduct backward and forward citation searching for included studies and relevant reviews. A systematic approach to searching, screening, reviewing and data extraction will be applied in accordance with the process recommended by the Cochrane Collaboration. Two researchers will examine titles, abstracts, full-texts for eligibility independently. Risk of bias will be assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomised controlled trials. Disagreements will be resolved by a consensus procedure.DiscussionHealth policy makers across government are expected to benefit from being able to increase compliance in clinical settings by applying theories of behaviour to design of policy communications. The synthesised findings will be disseminated through peer-reviewed publication.Systematic review registrationPROSPERO CRD42020167674
Highlights
Letters are regularly sent by healthcare organisations to healthcare professionals (HCPs) to encourage them to take action, change practice or implement guidance
Hallsworth [1] found that a letter containing a social norm message sent to general practitioners (GPs) notifying them that their practice is prescribing antibiotics at a higher rate than 80% of the practices in their local area reduced the prescribing rate compared to GPs who did not receive a letter
To address this research gap, we will conduct a systematic review that will identify what information and behaviour change techniques within letters that have the potential to optimise the effect on the behaviour of healthcare professionals
Summary
This knowledge synthesis can serve as a guide for effective interventions to support providers and health authorities with advice on how to formulate the communication, what information and BCTs to include in order to optimise the potential effect of letters on the behaviour of the receivers (HCPs). This guide will include a checklist that details step by step instructions on how to design, develop and test behaviourally informed communications. It will include tips, techniques and examples of how the methods outlined have been used successfully around the globe in recent years. The review is hoped to inform the development of the multi-step checklist, which will include sections such as Receiver, Action, Sender, Channel, Techniques. The review will inform the development of a multi-step checklist, which will include sections such as Receiver, Action, Sender, Channel, Techniques, giving important insights and practical applications for policymakers, health insurers, and health systems.
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